An analysis of the outcomes of totally implantable access port implantation performed by surgical residents

Purpose@#This study aimed to investigate the clinical outcomes after totally implantable access port (TIAP) implantation performed by general surgery residents in patients with colorectal cancer. @*Methods@#A total of 291 consecutive patients who underwent TIAP implantations were evaluated. The patients were divided into threegroups: second-, third-, and fourth-grade residents. @*Results@#The mean follow-up was 22.1 months (range, 1–87 months). The total times of operation, puncture, and cannulation decreased as the resident grade increased (P<0.001). Early complications significantly decreased with higher resident grades (P=0.039). The non-use of ultrasonography and non-use of C-arm were identified as independent risk factors for complications. Resident grades between second and third (P=0.005) and between second and fourth (P=0.041) were identified as independent risk factors for optimal tip position. @*Conclusion@#TIAP implantation can be safely and effectively performed by residents. Low-grade residents were associated with early complications.

An analysis of the outcomes of totally implantable access port implantation performed by surgical residents

Purpose@#This study aimed to investigate the clinical outcomes after totally implantable access port (TIAP) implantation performed by general surgery residents in patients with colorectal cancer. @*Methods@#A total of 291 consecutive patients who underwent TIAP implantations were evaluated. The patients were divided into threegroups: second-, third-, and fourth-grade residents. @*Results@#The mean follow-up was 22.1 months (range, 1–87 months). The total times of operation, puncture, and cannulation decreased as the resident grade increased (P<0.001). Early complications significantly decreased with higher resident grades (P=0.039). The non-use of ultrasonography and non-use of C-arm were identified as independent risk factors for complications. Resident grades between second and third (P=0.005) and between second and fourth (P=0.041) were identified as independent risk factors for optimal tip position. @*Conclusion@#TIAP implantation can be safely and effectively performed by residents. Low-grade residents were associated with early complications.

Short-course radiotherapy and chemotherapy for conversion surgery in patients with unresectable metastatic rectal cancer: a preliminary case series study

Purpose@#Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases. @*Methods@#The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion. @*Results@#Seven patients (five men and two women) underwent short-course RT (5 × 5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46–84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0–9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4–48.8 months and progression-free survival time of 14.7–41.1 months. @*Conclusion@#Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.

Is a Telephone Reminder Effective in Improving Retention Rate of Obese Patients?

Background: The purpose of this study was to evaluate the effectiveness of telephone call reminder on retention rate in obese patients. Methods: A total of 118 patients (85 first-time visitors, 33 re-visitors), who visited an obesity management clinic from May 2003 to May 2004, were divided into the intervention group (n=64) and the comparison group (n=54). The intervention was a telephone call reminder before the appointment date. The retention rate up to 7th visit and body mass index were compared between the two groups. Results: The retention rate was 64.4% at 4th visit (after 66.5+/-29.2 days from the first visit) and 36.4% at 7th visit (after 142.1+/-57.8 days from the first visit). For the first- time visitors, the retention rate at 3rd visit was significantly higher (85.1%) in the intervention group than those in the comparison group (67.6%, P=0.049). Otherwise, there were no significant differences in retention rate and body mass index at each visit between the two groups regardless of the visiting status. However, the body mass index at 4th and 7th visit was significantly lower in the intervention group than in the comparison group among the first-time visitors who completely attended 7 times (P=0.031). Conclusion: We could not find the telephone call reminder to be an effective method to improve retention rate in obesity management clinic. Further intensive approach is needed to promote attendance.